The current system for the research and development (R&D) of new medicines does not adequately meet the needs of the majority of the world’s population.

There is a lack of new medicines for the "neglected diseases"—those that primarily affect populations with little purchasing power, and therefore offer
an insufficient incentive for industry to invest in R&D. However, with problems extending far beyond the narrow notion of neglected diseases, the issue is better understood as one of "neglected populations."

International debate and proposals for reform have ensued, including the recommendation that governments begin negotiations over a binding medical R&D convention to address systematic, long-standing problems with innovation and globally equitable access to medicines. Despite the emergence of many new approaches to generating R&D that meets the needs of poorer populations, efforts remain ad hoc, fragmented, and insufficient.

We discuss how an R&D treaty could complement and build on existing initiatives by addressing four areas where the system remains particularly weak: affordability, sustainable financing, efficiency in innovation, and equitable health-centered governance.

We argue that effective tools for global governance are required to generate medical R&D as a global public good, based on the understanding that a politically and financially sustainable system will require both fair
contributions from all, and fair benefit-sharing for all.